Einschränkung der myokardialen Perfusionsreserve bei Mikrovaskular-Angina (Syndrom X): Nachweis durch ^99mTc-MIBI-SPECT

Zusammenfassung

Ziel: An 22 Patienten mit typischer Angina pectoris und normalen Koronararterien (Mikrovaskular-Angina, Syndrom X) wurde geprüft, ob mit ^99mTc-MIBI-SPECT eine Einschränkung der myokardialen Perfusionsreserve nachweisbar ist. Methode: Die Untersuchung mit ^99rnTc-MIBI-SPECT erfolgte in Ruhe und unter Vasodilatation nach einer Infusion mit Dipyridamol im Vergleich zu einer normalen Datenbank. Eine normale myokardiale Perfusionsreserve wurde bei einer differenziellen ^99mTc-MIBI-Aufnahme von > 20% angesehen. Ergebnisse: 2/22 (9%) der Patienten wiesen eine Perfusionsreserve <20% mit im Mittel 37% auf, 91 % der Patienten wiesen eine relativ oder absolut verminderte ^99mTc-MIBI-Aufnahme unter Vasodilatation auf. Bei 9/22 (41 %) Patienten war die Perfusionsreserve relativ gemindert mit einer Zunahme der ^99mTc-MIBI-Aktivität von 6%, bei 11/22 wurde eine Abnahme der ^99mTc-MIBI-Aktivität um 13% unter Vasodilatation dokumentiert. Schlußfolgerung: Bei guter Bildqualität ist die ^99mTc-MIBI-SPECT zur semiquantitativen Bestimmung der Perfusionsreserve bei Patienten mit Mikrovaskular-Angina geeignet.

Summary

Aim: In 22 patients with typical chest pain and normal coronary arteries (microvascular angina, syndrome X) ^99rnTc-MIBI-SPECT was examined in regard to assess impairment of myocardial perfusion reserve. Method: The study was performed with ^99rnTc-MIBI-SPECT at rest and under vasodilation with dipyridamole. The findings were compared with a normal database. A normal perfusion reserve was said to be an increase >20% of the ^99mTc-MIBI-activity. Results: In 2/22 (9%) of the patients the perfusion reserve lay >20% i.e. 37%. In 91% of the patients a diminution or even decrease of the perfusion was to be seen. From these 9/22 (41 %) of the patients showed a diminution of the ^99mTc-MIBI-upta-ke by 6%. 11/22 patients had a decrease of the perfusion under vasodilation with dipyridamole i.e. a lower activity of 99mTc-MIBI by 13%. Conclusion: Vasodilation ^99mTc-MIBI-SPECT offers good imaging quality and enables semiquantitative assessment of myocardial perfusion reserve in patients with microvascular angina.

Schlüsselwörter

Mikrovaskular-Angina - Syndrom X - myokardiale Perfusionsreserve - ^99rnTc-MIBI-SPECT

Keywords

Microvascular angina - syndrome X - myocardial perfusion reserve - tech-netium-MIBI-SPECT

• Literatur

• 1 Berman DS, Kiat H, Maddahi J. The new ^99mTc myocardial perfusion imaging agents: ^99mTc-Sestamibi and ^y9mTc-Teboroxime. Circulation 1991; 84 (Suppl. I): 1-7-1-21.
• 2 Boudoulas H, Cobb TC, Leighton RF, Wilt SM. Myocardial lactate production in patients with angina-like chest pain and angio-graphically normal coronary arteries and left ventricle. Am J Cardiol 1974; 34: 501-5.
• 3 Buell U, Kaiser HJ, Dupont F, Uebis R, Kleinhans E, Hanrath P. Methoxyisobtyliso-nitrile (MIBI) Tc 99m SPECT to establish a correlate to coronary flow reserve, the perfusion reserve, from global and regional myocardial uptake after exercise and rest. EurJNucl Med 1990; 16: 3-9.
• 4 Buell U, Schicha H. Nuclear medicine to image applied pathophysiology: evaluation of reserves by emission computerized tomography. Eur J Nucl Med 1990; 16: 129-35.
• 5 Camici PG, Gistri R, Lorenzoni R, Sorace O, Michelassi C, Bongiorni MG, Salvadori PA, L’Abbate A. Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation 1992; 86: 179-86.
• 6 Cannon RO, Watson RM, Rosing DR, Epstein SE. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1983; 1: 1359-73.
• 7 Cannon RO, Schenke WH, Leon MB, Rosing DR, Urqhart J, Epstein S. Limited coronary flow reserve after dipyrdidamole in patients with ergonovine-induced coronary vasoconstriction. Circulation 1987; 75: 163-74.
• 8 Chauhan A, Mullins PA, Petch MC, Schofield PM. Is coronary flow reserve in response to papaverine really normal in syndrome X?. Circulation 1994; 89: 1998-2004.
• 9 Galassi AR, Crea F, Araujo LI, Lammerts-ma AA, Pupita G, Yamamoto Y, Rechavia E, Jones T, Kaski JC, Maseri A, Taylor C, Lewington G. Comparison of regional myocardial blood flow in syndrome X and one-vessel coronary artery disease. Am J Cardiol 1993; 72: 134-9.
• 10 Garcia EV, Cooke CD, Van Train KF, Folks R, Peifer J, DePuey G, Maddahi J, Alazraki N, Galt J, Ezquerra N, Ziffer J, Areeda J, Berman DS. Technical aspects of myocardial SPECT imaging with technetium-⁹⁹”¹ Sesta-mibi. Am J Cardiol 1990; 66: 23E-31E.
• 11 Geltman EM, Henes CG, Senneff MJ, Sobel BE, Bergmann SR. Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angio-graphically normal coronary arteries. J Am Coll Cardiol 1990; 16: 586-95.
• 12 Glover DK, Okada RD. Myocardial kinetics of Tc-MIBI in canine myocardium after dipyridamole. Circulation 1990; 81: 628-36.
• 13 Holdright DR, Lindsay DC, Clarke D, Fox K, Poole-Wilson PA, Collins P. Coronary flow reserve in patients with chest pain and normal coronary arteries. Br Heart J 1993; 70: 513-9.
• 14 Kahn JK, McGhie I, Akers MS. et al. Quantitative rotational tomography with ²⁰¹T1 and ^99mTc 2-methoxy-isobutyl-isonitrile: a direct comparison in normal individuals and patients with coronary artery disease. Circulation 1989; 79: 1282-93.
• 15 Kaul S, Newell JB, Chesler DA, Pohost GM, Okada RD, Boucher CA. Quantitative thallium imaging findings in patients with normal coronary angiographic findings and clinically normal subjects. Am J Cardiol 1986; 57: 509-12.
• 16 Knop J, Thie A, Fuchs C, Siepmann G, Zeu-mer H. ““Tc-HMPAO-SPECT with acet-azolamide challenge to detect hemodynamic compromise in occlusive cerebrovascular disease. Stroke 1992; 23: 1733-42.
• 17 Kretschko J, Wellner U. Dosimetrie und Strahlenschutz. In: Nuklearmedizin. Büll U, Schicha H, Biersack H-J, Knapp W-H, Reiners Chr, Schober O. Hrsg. Georg Thieme Verlag; Stuttgart: 1994
• 18 Langes K, Volk C, Schneider MAE, Koschyk DH, Rinninger F, Nienaber CA. Die Bedeutung von Insulin-Resistenz und Hyper-lipoproteinämie bei Mikrovaskular-Angina (Syndrom X). Z Kardiol 1995; 3 (Suppl. 84) 180-9.
• 19 Liu P. New technetium ^99m imaging agents: promising windows for myocardial perfusion and viability. Am J Cardiac Imag 1992; 6: 28-41.
• 20 Meiler J, Goldsmith SJ, Rudin A. Spectrum of exercise ²⁰¹T1 myocardial perfusion imaging in patients with chest pain and normal coronary angiograms. Am J Cardiol 1979; 43: 717-23.
• 21 Nienaber CA, Spielmann RP. Dipyridamol-²⁰¹-Thallium-Perfusionszintigraphie bei Ko-ronarerkrankungen. Dtsch med Wschr 1988; 113: 1029-33.
• 22 Opherk D, Zebe H, Weihe E, Mall G, Dürr C, Gravert B, Mehmel HC, Schwarz F, Kubier W. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 1981; 63: 817-25.
• 23 Rosen SD, Uren NG, Kaski JC, Tousoulis D, Davies GJ, Camici PG. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994; 90: 50-60.
• 24 Strauer BE. Ventricular function and coronary hemodynamics in hypertensive heart disease. Am J Cardiol 1979; 44: 999-1006.
• 25 Strauer BE. The significance of coronary reserve in clinical heart diesease. Am J Cardiol 1990; 15: 775-83.
• 26 Tweddel AC, Martin W, Hutton I. Thallium scans in syndrome X. Br Heart J 1992; 68: 48-50.
• 27 West JW, Bellet S, Manzoli UC, Müller OF. Effects of Persantine (RA 8), a new coronary vasodilator, on coronary blood flow and cardiac hemodynamics in the dog. Circ Res 1962; 10: 35-44.